National Association of Social Workers

From the President

Embracing Clients' Cultural Values

By Elvira Craig de Silva, DSW, ACSW

Social workers often help with the adjustment, resettling and acculturation issues facing the many immigrants that have made the United States their home. From access to employment and education, to matters including individual and generational conflicts, as well as legal and health issues, social workers advocate and teach proactive skills to help immigrants and their families participate fully in our society.

At the 22nd NASW Delegate Assembly last month, social workers representing all 56 chapters approved two policy statements that affirm our profession's role in supporting immigrant transitions and ensuring culturally and linguistically competent services for all people.

Social workers recognize that the process of settling into another country can be arduous and sometimes painful. Even under the best circumstances, and with a positive attitude, people encounter difficulties and might feel isolated and alienated from the mainstream of society. In addition, states and communities are often unprepared to receive the numbers, and meet the special needs, of the newcomers. Services and programs can easily become overburdened and respond inefficiently.

Nowhere is this problem more evident — and dangerous — than in our nation's health care system.

Navigating culture. Culture generally provides a useful road map for living. However, many immigrants are not familiar with American cultural expectations and may feel awkward and distrustful when they don't understand unknown systems and situations.

To compound these frustrations, the adults in many immigrant families must depend on their children or grandchildren to navigate their new and confusing environment. Children are often the first ones to adapt to a new culture and become the de facto "translators" of that culture.

The experience can also create fear, and even anger, towards the institutions of the new country. Reciprocally, service providers can become impatient and frustrated when they do not have knowledge of their client's culture or have misperceptions about it. In other words, mutual stereotypes can impede successful communication and limit services.

Language barriers to health care. Language barriers further complicate the new immigrant's transition and can make obtaining basic medical care extremely difficult. When we feel sick — regardless of who we are or where we are from — we feel vulnerable. Hospital and clinic environments can be intimidating, particularly if we can't explain what is ailing us.

Although more than one in every nine people living in the United States is an immigrant, less than one-quarter of U.S. hospitals employ professionally trained interpreters at any level of medical care. Many other times, neighbors, children and relatives of the patient are asked to translate. Whatever the situation, it is not uncommon for serious mistakes to be made in gathering medical histories, providing accurate psychosocial evaluations and planning for treatment or discharge.

A recent study conducted by the NASW Connecticut Chapter on bilingual/bicultural workplace standards found that there are often not enough qualified individuals available to provide "accurate and nuanced interpretation services" at social service and health care organizations. Also, written materials are rarely available in clients' primary language.

The bilingual/bicultural social workers surveyed for this 2004 study also clarified that direct translation is not the same as interpretation and that a bilingual person still may not understand all bicultural issues. Formal training should be required and compensated.

Fortunately, more medical centers, universities and colleges are working to train and provide medical interpreters in their communities. In addition, federal legislation (Title VI of the Civil Rights Act) requires that hospitals and private practices that receive federal funds provide meaningful oral and written language assistance.

It is the position of NASW to promote cultural and linguistic competence in all areas of social work education, research and practice. To accomplish this, we must collaborate with consumers and their families, allied professions and cultural communities to create appropriate services, reasonable accommodations, interventions, programs and policies.

One of the most important things a social worker can do is to be aware of all available resources and to be sensitive to clients' cultural values. As social workers, it is our responsibility to increase our knowledge of the many issues affecting the health and well-being of all people, including immigrants with limited English proficiency.

We should encourage more bilingual/bicultural social workers to become trained and certified translators and interpreters so they can be compensated for the additional expertise they provide to employers. Furthermore, all social work practitioners and their host organizations must ensure that services are offered in the language preferred by the consumers and families they serve.

To comment to Elvira Craig de Silva: president@naswdc.org

From September 2005 NASW News. © 2005 National Association of Social Workers. All Rights Reserved. NASW News articles may be copied for personal use, but proper notice of copyright and credit to the NASW News must appear on all copies made. This permission does not apply to reproduction for advertising, promotion, resale, or other commercial purposes.